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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603383
Report Date: 01/17/2026
Date Signed: 01/17/2026 10:38:14 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/07/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250207091124
FACILITY NAME:TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THEFACILITY NUMBER:
198603383
ADMINISTRATOR:JAKINI, ROBERTFACILITY TYPE:
740
ADDRESS:1155 VIA VERDETELEPHONE:
(909) 293-6466
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:60CENSUS: DATE:
01/17/2026
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Anne Atrach - Activities DirectorTIME COMPLETED:
10:40 AM
ALLEGATION(S):
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Questionable death
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint visit to deliver findings on the above allegation. LPA met with Activities Director Anne Atrach and discussed the purpose of the visit.

The investigation consisted of the following:
On 2/10/25 LPA Wesley toured the facility and completed a 24 hour Health and Safety check, there were no concerns and LPA Wesley explained that either she or a respresentative from the Department of Social Services will complete the investigation on a later date. On 3/6/25 IB Investigator A.Luckett obtained a copy of R1's Death Certificate. On 12/17/25 IB Investigator A.Luckett received the toxicology report.
During todays visit LPA Herrera delivered findings on the reported allegation.

(continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 28-AS-20250207091124
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THE
FACILITY NUMBER: 198603383
VISIT DATE: 01/17/2026
NARRATIVE
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The Investigation Revealed the following:
Allegation: Questionable death.

It is alleged that R1's death is questionable due to being over medicated. This allegation was investigated by IB Investigator A.Luckett who began the investigation on 2/7/25. On 3/6/25 IB Investigator A.Luckett went in person to the Pasadena Public Health Department and obtained a copy of R1's Death Certificate with a date of death of 2/3/25 and cause of death listed as: Cardiac Arrest and Alzheimers Disease. On 3/11/25 a request for R1's toxicology report was sent. On 12/17/25 IB Investigator A.Luckett received the toxicology report, the laboratory results that were completed on 2/10/25 showed that tests completed on medications were Not Detected. After a thorough review of documents obtained, IB investigator A.Luckett did not see anything unusual or concerning with the cause of death.



Based on statements and interviews conducted, review of R1's file, facility records and medical records by IB investigator A.Luckett, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2026
LIC9099 (FAS) - (06/04)
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